The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Tuesday, March 23, 2010

Landmark health care plan passes

House Democrats rallied late Sunday night to pass President Obama's landmark health care overhaul plan and send to the president's desk the politically risky initiative, which Republicans vow to wield against the Democrats in November's mid-term elections. A companion package of repairs to the bill now heads to a Senate fight. But regardless of the outcome there, Mr. Obama's yearlong struggle for his signature initiative is just a stroke of his pen away from becoming law.

The Senate's health care bill squeaked through the House in a 219-212 vote, with 34 Democrats joining all 178 Republicans in opposition after a last-minute White House executive order convinced a small group of pro-life Democrats that the bill wouldn't fund abortions. The companion "fixes" bill passed 220 to 211, with 33 Democrats joining all 178 Republicans in opposition.

Democrats hailed the vote as one of the most significant change in American social policy since the creation of Medicare in 1965 or Social Security in 1935. "This is an American proposal that honors the traditions of our country," House Speaker Nancy Pelosi said, adding that access to health care is in the same league as the Declaration of Independence's claims about the inalienable rights to "life, liberty and the pursuit of happiness."

The 10-year, $940 billion overhaul plan aims to reshape the nation's health system by imposing new reforms on the insurance industry and guaranteeing insurance coverage to nearly all Americans with hopes of reducing health care costs and the federal deficit. "This is what change looks like," Mr. Obama said at the White House shortly after the vote, which he watched in the Roosevelt Room with Vice President Joseph R. Biden Jr.

Outside the Capitol, a few hundred protesters shouted "Kill the bill." Walking from a House office building to the Capitol on Sunday afternoon, Mrs. Pelosi linked arms with Rep. John Lewis, a Georgia Democrat who walked in the civil rights marches in Selma, Ala., in the 1960s and who said he was called a racial epithet by health care protesters on Saturday. Republicans called it an isolated incident and maintained their opposition to the health reform plan.

They argue that cuts to Medicare would undoubtedly hurt seniors' coverage, that insurance premiums for all Americans would spike, and that Democrats won't be able to make good on Mr. Obama's often-repeated promise that "if you like your plan, you can keep it." "The decisions we make will affect every man, woman and child in this nation for generations to come," Minority Leader John A. Boehner said. "This bill is not what the American people need." Mr. Boehner and Sen. Jim DeMint, South Carolina Republican, separately promised to introduce legislation to try to repeal the plan.

Mr. Obama, in his pitch to Democrats on Capitol Hill in recent weeks, said that much of his presidency is on the line with passage of his overhaul plan. It marks the most significant legislative accomplish of his presidency. But it would be a victory with a large asterisk. The Senate promised House members that it will be able to pass a companion bill to "repair" controversial provisions in the bill, such as a tax on high-cost insurance plans and state-specific deals that critics say were meant to buy votes. Mr. Obama could sign the Senate bill into law immediately. But doing so without the Senate repair bill would likely anger House members.

The debate over how to reform the $2.5 trillion health care industry has taken on a deeply partisan tone for more than a year. Many of the moderate Democrats who won Republican-leaning districts on Mr. Obama's coattails in 2008 acknowledged that their support may cost them their jobs this November as the overhaul hasn't polled well.

Democrats say that support will shift once Americans see the plan's benefits -- the poor will get tax credits to help them meet the requirement to buy insurance coverage; their insurance company won't be able to impose lifetime or annual caps on coverage or deny coverage because of pre-existing conditions; young adults can stay on their parents' plan until age 26; and Medicare's gap in drug coverage will be filled. It's paid for through cuts to Medicare funding, which Democrats say will only cut waste and fraud, and a new Medicare tax on unearned income, such as investment profits, of couples making over $250,000 and individuals making over $200,000.

Abortion threatened to hold up the vote until almost the last minute. A group of about 10 pro-life Democrats said they wouldn't vote for the Senate plan unless they had a guarantee that it wouldn't allow for federal funding of abortions. They were concerned the bill would allow federal tax subsidies to fund insurance policies that cover the procedure and that funding for community health centers would not come with a prohibition on covering abortions. But their objections were met with an executive order Mr. Obama issued on Sunday affirming that the bill wouldn't do so.

Catholic groups have been divided over whether the Senate bill would authorize the federal funding of abortions, with the U.S. Conference of Catholic Bishops staunchly opposed to the Senate plan; but others, such as a group of hundreds of nuns, endorsed the plan last week. Catholic Advocate, a 501(c)(3) lobbying group, said Sunday that passing the Senate bill would account for one of the greatest expansions of abortion since the landmark Roe v. Wade Supreme Court ruling and promised to contest House members who supported it.

But the executive order was thought to be enough to push Democrats over the 216 mark required for passage. The companion reconciliation bill would remove the Senate's tax on high-cost insurance plans, federal funding for Nebraska's Medicaid costs and other problems House members had with the Senate plan. The Senate is expected to start work on the bill on Tuesday.

Over the weekend, Democrats decided against using a controversial procedure, called "deem and pass," that would have allowed both bills to pass with one vote. Republicans had called it a parliamentary trick. The vote required House members to take a bit of a leap of faith that the Senate was going to be able to deliver on the companion bill. They now have no leverage left since the Senate bill can go to Mr. Obama's desk and become law despite their grave misgivings about it. Senate Democratic leaders are expected to easily come up with the 51 votes they need. "There's a strong desire to do what's in that bill," Sen. Debbie Stabenow, Michigan Democrat, told reporters last week.

But it's a potentially difficult climb for the Senate as reconciliation rules allow Republicans to introduce an unlimited number of amendments and require each provision of the bill to affect the budget or be struck by the Senate's nonpartisan parliamentarian. If the bill is changed at all, in the form of amendments or budget strikes, it will have to go back to the House for another vote, throwing another wrench into the process.

Republicans have promised a fight, warning they plan to put up every procedural obstacle they can. They've already eyed parts of the bill that they contend are not related to the budget and can be brought up as a violation of the so-called "Byrd" rule.

Mrs. Pelosi said Friday that she doesn't foresee any Byrd-rule violations surviving. "We tried to have a 'Byrd' scrub," she said, but "the parliamentarian would not necessarily give us definitive answers on anything."

Republicans said Sunday they like their chances on an objection that the bill affects Social Security, which would be a violation of budget rules. If the parliamentarian agrees and the presiding officer of the Senate upholds the decision, Democrats would need 60 votes to override the decision. All 41 Republicans recently signed a letter saying they will object to overriding the parliamentarian. "We've informed our colleagues in the House that we believe the bill they're now considering violates the clear language of Section 310g of the Congressional Budget Act, and the entire reconciliation bill is subject to a point of order and rejection in the Senate should it pass the House," said Don Stewart, spokesman for Senate Republican leader Mitch McConnell of Kentucky.

The government takeover of health care will go down in history as the worst piece of legislation to emerge from a Congress held in general disdain by the American people. The only bipartisanship on the health bill was in the opposition.

Usually autopsies are reserved for after the patient has died, but in this case it is useful to get ahead of the matter. The malformed health legislation is not the only reason Democrats are facing political extinction in November, but it is one of the most dramatic. The legislative process in this country has never been so unseemly. Arm twisting, backroom deals, special privileges and potentially criminal "government jobs for votes" agreements became a normal way of doing business. House Speaker Nancy Pelosi fixated on the mantra that the Democrats' health plan is "historic," but so was the Black Plague.

President Obama went to Capitol Hill on Saturday to give a final pep talk to Democrats, where he absurdly called his socialist health care measure "one of the biggest deficit reduction measures in history." This contradicts the chief actuary at the Centers for Medicare and Medicaid Services, who says his staff currently has no idea what the impact of the plan is "due to the complexity of the legislation." Democrats have been hoodwinked into believing they won't pay a political price for their actions, but they will soon discover they miscalculated.

The new system will suffer a tsunami of bad publicity when states sue the federal government over unfunded mandates, when the IRS begins enforcing the aspects of the bill that voters never knew existed, when small businesses start firing employees because they cannot afford the higher costs of the new system, when new and unforeseen costs blow out the already record federal budget deficit, and when seniors begin to feel the impact of Medicare cuts. All of this is what Mr. Obama euphemistically calls "bending the curve" but which seniors will find out is better termed "denial of care." Whether the formal "death panels" will convene before the November elections is still to be determined.

Many members of Congress probably don't know exactly what is in the bill. The 2,300 pages of "fixes" to the Senate bill presented last week were only a draft, and no member can be certain what has been slipped in. A frantic Democratic Party memo sent out Thursday instructed members -- twice, in italics -- not to "get into a discussion of details of the [Congressional Budget Office] scores and the textual narrative" with the bill's opponents. But the devil was in those details. Mrs. Pelosi's offhand statement that members would learn what was in the bill after it was passed should have been a warning.

The majority party was even having problems over the weekend determining if they could vote to amend a law before it was signed by the president. It is a sad day for America when senior members of Congress either dont understand the Constitution or no longer think it applies.

Democrats in Congress refuse to believe the contempt with which the American people hold them. Gallup shows congressional approval ratings in the teens and headed downward. Gallup also found that "more Americans believe the new legislation will make things worse rather than better for the U.S. as a whole, as well as for them personally."

Democrats are in much worse shape than in 1994 when they lost power, and the opposition is far more energized. Once voters have a chance to tell the most irresponsible government in American history that enough is enough, the Democrats' brief reign will expire, and be deemed death by suicide.

A five-year-old girl with severe burns was turned away from hospital and her parents forced to drive 25 miles before doctors would treat her. Madison Healy was turned away from Coventry's University Hospital after her clothes caught fire in a freak accident at home. Her mother Alana Regan, 27, took her to A&E, expecting her daughter's injuries to be treated swiftly.

Instead, she says a doctor merely "poked at her leg" before telling her and her partner John Austin, 33, they would have to drive Madison to a specialist burns unit 25 miles away themselves. The Coventry couple, who had no money for petrol and did not know the way drove for an hour before doctors at Birmingham Children's Hospital were able to treat her. There it was discovered Madison had third degree burns requiring a skin graft plus years of treatment and physiotherapy in the future.

Now, Ms Regan has filed an official complaint against University Hospital, saying they let down her seriously injured child. Ms Regan said: "She is only a five-year-old girl and she should have been treated with more priority. "She suffered long term, life-changing injuries and they should have treated her with more compassion and urgency."

A spokesman for University Hospital said Madison had been seen by triage staff within four minutes of arriving at A&E and given painkillers. He added within 50 minutes she went on to be reviewed again by a doctor. "In line with our pediatric pathway relating to burns and scalds Madison was referred to Birmingham Children's Hospital who were advised to expect her arrival and provide ongoing specialist service.

"As the burn was categorised as a small burn covering less than one per cent of the total body surface it is considered safe and within guidelines to transfer by car with a written referral and full directions. "The Trust do apologise if the family felt distressed, however Madison did not require resuscitation or treatment during her transfer."

No comments:

Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here